Registered Nurse (RN) Clinical Documentation Denials Auditor

Inova Health is looking for a dedicated Registered Nurse (RN) Clinical Documentation Denials Auditor to join the team. This role will be fully-time remote, Monday-Friday, regular business hours 8:00 AM – 4:30 PM (flexible).

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. 

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities.

Registered Nurse (RN) Clinical Documentation Denials Auditor Job Responsibilities:

• Evaluates specificity and completeness of physician documentation to ensure optimal coding (e.g. mortality outcomes using APR-DRG, SOI and ROM, appropriate reduction of complications based on PSI and HAC, revenue assurance outcomes based on reimbursement DRG (MS-DRG), documentation of significant chronic conditions affecting resource utilization based on HCC).
• Summarizes audit findings for individual records along with specific documentation guidelines to improve expected clinical outcomes for an individual physician, physician practice, or specialty.
• Conducts follow-up audits (i.e. concurrent or post-discharge) with routine feedback until documentation practice comes into line with expected clinical outcomes.
• Works with Clinical Documentation Improvement (CDI) Director and Lead Auditor on other work related to physician audits and education programs.
• Demonstrates proficiency with Cobius to access external audit work, record summary results and upload appeal letters.
• Demonstrates proficiency with Encompass 360 and HDM audit functions to review electronic medical records with advanced functions (i.e. ex, auto-suggest and search) and record detail coding audit results.
• Showcases proficiency in reviewing records in Epic electronic medical records – which may be the only option for audits of older records.
• Demonstrates proficiency in writing effective appeal letters that include appropriate coding guidelines and medical references.
• Identifies trends in external audit findings related to coding quality and physician documentation. Prepares educational communications related to these findings.
• Evaluates physicians' documentation, diagnostic reports, and clinical findings for validation of diagnoses.
• Processes the requests for second opinion reviews when clinical validity is not supported or in question.
• May perform additional duties as assigned.

Minimum Qualifications:

• Certification: Certified Coding Specialist / Certified Clinical Documentation Specialist; ACDIS/AHIMA certification, CCDS or CDIP
• Licensure: Registered Nurse Upon Start Current RN license and eligible to practice in VA or MD
• Experience: Seven years of recent CDI, DRG validation or coding audit experience in an acute hospital setting with clinician training as RN, BSN, NP, PA or MD; Coding certification CCS and CDI certification CCDS or CDIP
• Education: Associate Degree in Nursing or Medicine.

Preferred Qualifications: 

• Experience: Recent coding experience. Clinical background and coding + denials knowledge. Experience writing denials & appeals. Outpatient and/or inpatient experience. Knowledge to identify clinical indicators (example: sepsis). EPIC experience.
• Certifications: CCDS
• Skills: presenting

Remote Eligibility: This position is eligible for remote work for candidates residing in the following states – VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV